As reported by MedPage Today:

“Federal prosecutors are looking into physicians’ prescribing practices relating to implantable cardioverter defibrillators (ICDs), the Heart Rhythm Society has told its members.

In a mailing sent to HRS members, the group said it had been contacted by the Department of Justice to assist in a probe of ICD prescribing.

“[HRS] has agreed to assist in an advisory role to lend expertise concerning proper guidelines for clinical decision making,” according to a copy of the notice posted by two members on the Internet.

The notice indicated that the society was prohibited from commenting further on its role in the investigation. Justice Department officials could not be reached for comment.

It was therefore unclear whether the probe is related directly to a report in the Journal of the American Medical Associationrecently indicating that ICDs are often prescribed for patients who don’t qualify for the devices under published guidelines…

The HRS notice appears to raise the possibility that the Justice Department may be considering prosecution of individual clinicians, in addition to its already disclosed investigation into alleged payola schemes by ICD manufacturers.”

If the Justice Department investigation is, in fact, going to target clinicians based upon their adherence to guidelines, the American healthcare system is headed down a very slippery slope.  Government regulators and prosecutors will, of course, contend that they’re simply looking for “waste, fraud and abuse”, and that looking for non-adherence to guidelines is a reasonable screening tool when looking for criminals.  But let’s not kid around.  Any such policy is going to have a chilling effect on treating patients as individuals rather than statistically average widgets.  You may need a test or procedure as a part of good medical care, but your doctor is going to be too scared to order it if her record of “guideline compliance” is at stake.


These actions should come as no surprise. The writing is on the wall.

Part of the electronic health system is to have “suggested” protocols when the diagnosis and symptoms are keyed in.
If the doctor veers from the protocols, he/she must enter the reasoning behind it in the notes. These notes will be monitored by the government.

Questions to ask are:
*Who is devising this set of protocols?
*Are the guidelines based on cost or the best option?
*Will physicians lose the right or ability to devise protocols that are individualized for each patient and ones that the provider feels is in the best interest of the patient?
*Will the doctor become unable to offer various options if they are more expensive?

As the medical community moves forward and transitions to electronic records, it will be much easier for “big brother” to monitor treatments. Good for some (protective), bad for many.
Incidentally, what will the government do with all the “personal” information?